AirSense 11 AutoSet CPAP Machine

Product Information

Specifications

• Product Name: ResMed AirSenseTM 11
• Manufacturer: Apria
• Model: AirSense 11
• Product Type: CPAP Machine
• Compatibility: Works with ClimateLineAir 11 heated tubing

Product Usage Instructions

Step 1: Get Started

Start your therapy tonight so you can feel refreshed in the
morning.

Step 2: Get Familiar With Your PAP Equipment

If your doctor prescribed a specific mask and size, follow the
fitting instructions provided by the manufacturer, then proceed to
Step 3.

Nasal Mask

Please refer to the manufacturer’s instructions for additional
information on topics related to the nasal mask.

Nasal Pillow Mask

Refer to the manufacturer’s instructions for additional
information on topics related to the nasal pillow mask.

Full-Face Mask

Check the manufacturer’s instructions for additional information
on topics related to the full-face mask.

How to Attach Oxygen to Your PAP Machine

If you are using non-heated tubing and prescribed oxygen, follow
these steps:

1. Attach the oxygen tee adapter to your PAP machine.

2. Connect the large-bore PAP tubing to the oxygen tee
   adapter.

3. Connect the small-bore oxygen tubing to the oxygen tee
   adapter.

ClimateLineAir 11

The ClimateLineAirTM 11 is a heated tube that delivers air to a
compatible mask. It helps in providing relief from dryness and
congestion.

IMPORTANT: If using prescribed oxygen with your
PAP device, follow the safety guidelines for oxygen use and turn
on/off the oxygen flow correctly in relation to the PAP
machine.

Frequently Asked Questions (FAQ)

Q: How do I know if I need to change the mask cushion

size?

A: If your mask is leaking or feels uncomfortable during
therapy, try changing the mask cushion size. Always use the larger
cushion if you are between sizes.

Q: Do I need the oxygen tee adapter for using prescribed oxygen

with my PAP machine?

A: Yes, you need to attach the oxygen tee adapter to your PAP
machine when using prescribed oxygen. Follow the provided
instructions for proper setup.

Apria.com/KaiserSleep
Your Apria Sleep Therapy
User Guide ResMed AirSenseTM 11

Apria is Your Home Medical Equipment Provider
Your doctor has prescribed PAP therapy because you have been diagnosed with sleep apnea. Sleep apnea occurs when a person repeatedly stops breathing for 10 or more seconds at a time while sleeping. These events may occur hundreds of times throughout the night, causing oxygen levels in the blood to drop, putting stress on the heart. If left untreated, sleep apnea is linked to many other serious conditions like high blood pressure, diabetes, heart disease, and stroke. This guide contains easy step-by-step instructions for using your PAP equipment and is designed to help you benefit from therapy as soon as your equipment arrives. Please visit Apria.com/KaiserSleep for all of this information and more.
You can also scan this code with your smartphone:
Your Device and Settings
Your CPAP machine has already been programmed with the settings your physician prescribed.
OVERVIEW | 1

STEP 1
Get Started
Start your therapy tonight so you can feel refreshed in the morning.
To set up the device: Place the device on a stable level surface. Connect the power cord into the power inlet at the rear of the device. Connect one end of the power cord into the AC adaptor and the other end into the power outlet. Ensure the device is set up and connected to power to enable settings to be applied wirelessly to the device, if required. Connect the tubing firmly to the outlet connector at the rear of the device. If you were supplied with the ClimateLine heated tubing, one end will have an electrical connector on it. Connect this end to the back of the device with the connector facing up. Open the humidifier water tub and fill it to just below the maximum fill line with distilled water. The humidifier tub must be removed from the device before adding water. The humidifier tub has a maximum capacity of 380 mL. Close the humidifier tub and insert it into the side of the device. Connect the free end of the air tubing firmly onto the assembled mask.
See the mask user guide for detailed information. NOTES: · Do not insert any USB cable into the AirSense 11 device or attempt to plug the AC adaptor
into a USB device. This may cause damage to the AirSense 11 device or USB device. · The electrical connector end of the heated air tubing is only compatible with the air outlet
at the device end and should not be fitted to the mask. · Do not use electrically conductive or anti-static air tubing.
2 | STEP 1: GET STARTED

STEP 2
Get Familiar With Your PAP Equipment
If your doctor prescribed a specific mask and size, follow the fitting instructions provided by the manufacturer, then proceed to Step 3. If you received a mask with cushions of multiple sizes, follow the instructions below and on the next page.
There is a mask cushion currently attached to the frame of your mask. This size fits most patients. Once you begin therapy, if your mask is leaking or feels uncomfortable, try removing the existing cushion and replacing it with a different size cushion. If you are between sizes, it is best to use the larger cushion. Use the fitting template (for nasal mask and full-face mask) and/or the manufacturer’s instructions included with your mask for help.
myAirTM is a smartphone app that guides you through the setup process. See page 14 of this booklet for more information.

Mask Cushion Tubing

Adjustable Headgear Mask Frame

STEP 2: GET FAMILIAR WITH YOUR PAP EQUIPMENT | 3

Nasal Mask
Release the lower strap from the frame of the mask. Make sure the logo on the headgear is facing outward. While holding the mask against your face, pull the headgear over your head. Position the lower straps so they both sit below the ears and adjust so they are snug. Adjust the fastening tabs on the upper straps until the mask feels even and stable. Do not over-tighten. Reattach the fastening tabs. Repeat Step 3 with the lower straps. Reattach the fastening tabs. Connect the hose to the front of the mask. Ensure that the nasal mask fits securely over your nose. It is normal to feel some air escaping through the small air vents on the elbow of the hose.
Please refer to the manufacturer’s instructions for additional information on topics, such as:
· How to properly remove your mask. · How to remove and change the mask cushion. · How to adjust the length of the mask straps.
4 | STEP 2: GET FAMILIAR WITH YOUR PAP EQUIPMENT

Nasal Pillow Mask
Hold the pillows away from your nose with the left (L) and right (R) indicators correctly facing toward you. Guide the nasal pillows into your nostrils. Pull the headgear over your head by holding the bottom strap and stretching it around the back of your head. Adjust the top and bottom straps. The top strap should fit comfortably on the top of your head. Ensure that the nasal pillows fit securely into your nostrils, with both pillows positioned upright. If not, move the mask away from your face and then place it back again. To achieve a comfortable fit, adjust the straps. Spread the straps apart to loosen, or draw them closer together to tighten. If the headgear comes with a buckle, adjust the headgear by pulling the headgear through the buckle to fix mask leaks. Adjust only enough for a comfortable seal and do not overtighten. The headgear may need to be adjusted as it can stretch over time.
STEP 2: GET FAMILIAR WITH YOUR PAP EQUIPMENT | 5

Full-Face Mask
Twist and pull both magnetic clips away from the frame. With the logo on the headgear facing outward, hold the mask against your face and pull the headgear over your head. Bring the lower straps below your ears and attach the magnetic clip to the frame. Undo the fastening tabs on the upper headgear straps. Pull the straps evenly until the mask is stable and positioned as shown in the illustrations. Reattach the fastening tabs. Undo the fastening tabs on the lower headgear straps. Pull the straps evenly until the mask sits firmly on the chin and reattach the fastening tabs. Connect the air tubing from your device to the elbow. Attach the elbow to the mask by pressing the side buttons and pushing the elbow into the mask. To achieve a comfortable fit, readjust the straps. Evenly apply only enough tension so that a seal is achieved.
Please refer to the manufacturer’s instructions for additional information on topics, such as:
· How to properly remove your mask. · How to remove and change the mask cushion. · How to adjust the length of the mask straps.
6 | STEP 2: GET FAMILIAR WITH YOUR PAP EQUIPMENT

How to Attach Oxygen to Your PAP Machine

If you are using non-heated tubing, and you are also using prescribed oxygen, follow these instructions.

Attach the oxygen tee adapter that was included in the box to your PAP machine.

Next, attach the large-bore PAP tubing to the oxygen tee adapter. Finally, connect the small-bore oxygen tubing to the oxygen tee adapter.

Oxygen Tee Adapter

For detailed instructions on oxygen use, you should also review the PAP and oxygen manufacturer’s user guides included in your package. If you did not receive the oxygen adapter, please call the supply department at 877.265.2426, option 2.

IMPORTANT SAFETY NOTE: If you are using prescribed oxygen with your PAP device, be sure to observe all the fire and safety rules associated with the use of oxygen. Follow this sequence of steps when turning your oxygen on and off. 1. Always turn your PAP machine ON before turning ON the oxygen flow from your oxygen source. 2. Always turn OFF the oxygen flow from your oxygen source before turning OFF the PAP machine.

ClimateLineAir 11
The ClimateLineAirTM 11 is a heated tube that delivers air to a compatible mask. When used with the device tub, ClimateLineAir 11 heated air tubing allows you to use the Climate Control feature.
ResMed’s Climate Control solution is designed to offer relief from dryness and congestion.
When using ClimateLineAir tubing, your device will automatically default to Climate Control Auto when you plug the tubing into the machine (unless your doctor has prescribed a specific heat and humidity setting).

STEP 2: GET FAMILIAR WITH YOUR PAP EQUIPMENT | 7

Climate Control
Climate Control is designed to make therapy more comfortable by enabling constant temperature and maintaining humidity. Features of Climate Control:
· Delivers comfortable humidity level and temperature during therapy. · Maintains the set temperature and relative humidity during sleep to prevent
dryness in the mouth. · Can be set to either “Automatic” or “Manual.” · Is available only when both the ClimateLineAir and HumidAirTM tub are attached. If you have the ClimateLineAir heated tubing and would like to change your humidity level, go to the devices display screen and make adjustments. On the display screen, choose “My Options” and then “Climate Control.” Switch the setting from “Automatic” to “Manual” and then adjust your humidity level and tubing temperature to a setting that is comfortable to you.
Setting Up the Device and Tubing
Make sure the device is turned on. Hold the cuff of the heated air tubing and line up the tubing with the outlet connector at the rear of the device. Push the cuff firmly into place. “ClimateLineAir connected” will briefly display on the device screen. Connect the assembled mask to the free end of the heated air tubing. NOTE: The electrical connector end of the heated air tubing is only compatible with the air outlet at the device end and should not be fitted to the mask.
8 | STEP 2: GET FAMILIAR WITH YOUR PAP EQUIPMENT

STEP 3
Start Your PAP Machine
To start therapy:
Power on the PAP device. Ensure that your prescribed settings are visible on the bottom portion of the screen. Fit your mask and put it on. Connect the tubing to the mask.
Your machine may have an auto on feature enabled. If so, the machine will automatically start when you put on the mask and start breathing. If after four breaths your device does not turn on, verify your mask is fit properly with no leaks. If it still does not turn on, you can press the power button on top of the device to turn it on.
Check for air leaks. Small leaks are acceptable. If large leaks occur, try the following: · Grasp the mask frame and lift it away from your face. The cushions should also lift off your face. Lightly place the mask back on your face. · If large leaks still exist, adjust the headgear. If the headgear is either too tight or too loose, it can cause leaks. · Additional tips for managing mask leaks are provided on the next page. You should also review the manufacturer’s user guides provided in your package.
STEP 3: START YOUR PAP MACHINE | 9

Helpful Tips
For Nasal and Full-Face Masks
· To resolve leaks at the upper part of the mask, adjust the upper headgear straps. · For leaks at the lower part, adjust the lower headgear straps. · When adjusting straps, loosen or tighten both the left and right straps so that adjustments
are made evenly. · Adjust only enough for a comfortable seal. · The upper strap adjustment is the key to seal and comfort. · Do not overtighten the lower straps. They mainly serve to keep the cushion in position. · If mask continues to leak after tightening, cushion may need to be changed.
NOTE: With a nasal mask, it is important to breathe in and out through your nose only.
For Nasal Pillow Masks
· Position the pillow cushion tips into your nostrils so they sit comfortably under your nose without any gaps. Pull the mask away from your face, then place it back to get a comfortable fit.
· Adjust the side straps evenly by pulling downward; the mask should feel secure and comfortable against your face. Do not overtighten.
· If leaks persist, try the next larger set of cushions. · If the pillow is not staying in place in your nostrils, try the next smaller cushion size.
Handwashing Technique
Thorough handwashing must be done prior to all procedures. Contaminated, dirty hands are one of the most common sources of infection.
Wet your hands thoroughly with warm water. Use soap. Scrub hands for 20 seconds using a rotary motion and friction. Wash: · Back and palm of each hand · Between all fingers · Fingernails
Need a timer? Hum the “Happy Birthday” song from beginning to end twice. Rinse your hands under the running water. Dry on clean towel or with a paper towel.
For additional good health habits, visit our patient education section on Apria.com/KaiserSleep
10 | HELPFUL TIPS

Get Comfortable With Your Therapy
Use your PAP therapy during all hours of sleep, including during naps. Some people may need up to one or two weeks to adjust to PAP therapy, but the benefits are well worth it.
Ways to help you adjust: · Try watching TV or reading while wearing your mask and headgear. · Turn on the PAP device for short periods of time while wearing your mask to get used to the pressure. · Use your equipment every night. · Keep the device turned on for as long as you can tolerate, building up each night until you have reached at least 4 hours per night. · Keep practicing until you are using PAP therapy during all hours of sleep, including during naps.
GET COMFORTABLE WITH YOUR THERAPY | 11

Track Your Progress
myAirTM is a smartphone app that guides you through the setup process. This includes setup videos, mask fitting videos, trying therapy using the Test Drive Feature, and tracking your sleep health progress. The app is not required to set up or use the device. The device can be used without the app or, if you choose, you can decide to install the app at a later time. If you decide to install the app at a later time, data will only be shown from the day you download it. Connect to myAir
Ensure your AirSense 11 device is set up correctly and plugged into a power source. Launch the myAir app. Tap Continue. Follow the prompts on the myAir app to complete the Bluetooth connection. AirSense 11 is now connected to the app. The Bluetooth connection symbol appears on the status bar to confirm the connection between the AirSense 11 device and the smartphone. If the 4 digit code does not populate on the AirSense 11 screen, you can select +More from the home screen. Then select MyAir app and the 4 digit code should populate. Tap Done.
The app can be delayed in downloading data from the previous night. Check back around 12:00 p.m. and if the device has not updated, call us to ensure the device is transmitting.
12 | TRACK YOUR PROGRESS

Get Support
If you are having difficulties getting used to therapy, try using your machine’s “comfort features” to help.
Do you have a dry nose or throat, or a runny nose? Increase the humidity level. Are there droplets of water or condensation inside your nose, mask, or tubing? Decrease the humidity level. To change Humidity Level, see below. Is the air pressure making it difficult for you to fall asleep? Turn on the Auto Ramp or increase the Ramp Time. Do you feel bloated? You may be swallowing air. Turn on the Auto Ramp or increase the Ramp Time. Do you feel like you are not getting enough air? Turn the Ramp Time to “off.” To change Ramp Time, see below. Do you have sore or dry eyes? Adjust your mask or headgear. It may need to be repositioned. Refer to the instructions provided in the manufacturer’s user guide for your mask. Also review Steps 2 and 3 in this guide. Are you experiencing redness on your face where the mask touches the skin? Your mask may be too tight. Try adjusting your headgear. If redness persists, contact Apria. Do you have nasal, sinus, or ear pain? You may have a sinus or ear infection. Stop using your machine and contact your doctor.
To update the setting for Ramp Time or Humidity Level, tap MY OPTIONS from the Home screen, go down the list of options, and select the setting.
Tap Ramp Time or Humidity Level. Tap the preferred setting. Tap OK to save the change.
This information is intended for your general knowledge only and is not a substitute for medical advice or treatment for a specific medical condition. Should you have any healthcare-related questions, please consult your doctor.
GET SUPPORT | 13

Cleaning Your PAP Equipment
The following instructions are for home cleaning. Instructions for reprocessing devices intended for multi-patient re-use can be found in the clinical guide.
You should clean the device, humidifier tub, air tubing, and outlet connector as described.
Daily: Empty the humidifier tub and wipe it thoroughly with a clean disposable cloth. Allow it to dry out of direct sunlight. Refill the humidifier tub with distilled water just before using.
Weekly: Wash the components using one of the following options: · Wash the humidifier tub, air tubing, and outlet connector in warm water using a mild, clear, and unscented dishwashing liquid. Components should not be washed in temperatures higher than 149°F (65°C). OR · Wash the humidifier tub and outlet connector in a solution of 1 part vinegar and 9 parts water. The air tubing should be washed in warm water using a mild, clear, and unscented dishwashing liquid. The air tubing should not be washed in temperatures higher than 149°F (65°C). Rinse each component thoroughly in water. Allow to dry out of direct sunlight or heat. Wipe the exterior of the device with a dry cloth.
NOTES: · The humidifier tub may be washed in a dishwasher on the delicate cycle (top shelf only). · Do not wash the heated air tubing in a dishwasher or washing machine. · The air filter is not washable or reusable.
For cleaning your mask, refer to the mask user guide for detailed instructions.
14 | CLEANING YOUR PAP EQUIPMENT

Replace Supplies Regularly
Replace your sleep supplies regularly. This helps to ensure a good mask seal and reduce buildup of bacteria, viruses, and allergens. Ordering fresh, clean supplies to replace your old items helps improve the comfort of your mask and maintains the overall effectiveness of your therapy.

Recommended Replacement Schedule

Twice Monthly
· Nasal mask cushions and nasal pillows

Once Monthly
· Full-face mask cushions · Disposable filters

Every 3 Months
· Mask frame · Tubing (standard or heated)

Every 6 Months
· Headgear and chin straps · Humidifier water chamber · Non-disposable filters

Please note that the frequency of resupply and your insurance coverage is administered by Kaiser Permanente and may differ from the schedule provided above.
For more details on our various sleep resupply self-serve ordering options, visit our dedicated Kaiser Permanente Sleep website at Apria.com/KaiserSleep

Source: 1. Horowitz A, Horowitz S, Chun C. CPAP Masks are Sources of Microbial Contamination. SleepHealth Centers, Div. of Sleep Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston. APSS Poster; 2009.
REPLACE SUPPLIES REGULARLY | 15

Convenient Ordering Options
When ordering fresh supplies through Apria, shipping is always free, and we verify and bill your insurance for you.
Order Online
Apria.com/PAPresupply — Register for the PAP Patient Portal with your Apria Patient ID and place an order when you need new supplies. ApriaDirect.com — Order supplies anytime on the retail (non-insurance) website.
Call Our Automated System
Dial 800.436.5657 to use Apria’s automated phone system, available 24/7, to place your order.
Speak With an Customer Service Specialist
Dial 800-492-8901 to order supplies with an Apria sleep supplies specialist. Monday through Saturday 7am – 10pm CT For trouble shooting assistance with your machine, dial 888-452-4363
16 | CONVENIENT ORDERING OPTIONS

SAFETY GUIDELINES
Surviving a Fire in Your Home
Take the time now to prepare — it can save lives!

An Ounce of Protection…
Smoke Alarms · Install a smoke alarm outside of each sleeping area and on each additional level of your home. · Install smoke alarms INSIDE sleeping areas if people sleep with their doors closed. · Test smoke alarms once a month by pressing test buttons. · If an alarm fails the test or starts making beeping noises, replace batteries immediately. · Replace ALL smoke alarm batteries at least once a year.
Fire Extinguishers · Consider purchasing one or more fire extinguishers to keep in your home. · Read the instructions to understand how your fire extinguisher works, and make sure all family members understand how to use it. · Read the instructions to find out how to check if your extinguisher is in working order, and how frequently it needs to be checked.
Escape Ladders · Consider installing escape ladders for upstairs rooms. · Learn how to use your escape ladder. · Store ladders close to windows.
Flashlights · Keep flashlights throughout your house and make sure everyone knows where they are located. · Check batteries regularly.
Planning Can Prevent Panic
Escape Routes · Figure out at least two ways for escaping for every room in your home. · Everyone living in your home should be familiar with these escape routes.
Practice · At least twice a year, practice using your escape plans. · Practice crawling because you may need to escape by crawling under smoke, where the freshest air will be.

Meeting Place · Decide on a location where everyone will meet outside your home after escaping from a fire. · A meeting place is important so that you can quickly see if everyone has escaped.
If a Fire Occurs…
Making Your Escape · If there is smoke or fire in one escape route, use another route. · If there is no way to avoid smoke, remember to stay low and crawl under the smoke, where the freshest air will be. · If you want to escape by opening a closed door, FIRST check to see if the door feels warm before opening it. If it is warm, do NOT open the door. Instead, use another route.
Blocked Escape Routes If all of your escape routes are blocked by smoke, heat, or flames:
· Stay in the room and keep any doors closed. · Keep out smoke by piling rugs, blankets, or pillows
along the bottom of any doors. · If there is a phone in the room, call 911 and tell them
where you are. · Signal out a window for help using a brightly colored
cloth, sheet, towel, or flashlight. · Stay as close to the floor as possible, near a window
or door.
After Escaping · Go to a neighbor’s house and call 911 as soon as possible. · NEVER go back inside a burning house. Once you’re outside, stay outside! · When firefighters arrive, tell them if you think anyone is still inside.

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SAFETY GUIDELINES
Tips to Avoid Falling
Reduce your chances of falling by making home improvements and changing some habits.

Look Around Your Home
Floors · Keep the areas where you walk free from clutter, electrical and telephone cords, and other small objects that might be easily overlooked. · Secure loose rugs and mats with carpet tape or attach non-slip backing. · For tile or wooden floors, avoid wax or use nonskid wax. · Stairs should have flat surfaces. Repair holes or tears in carpeting and make sure it is well attached. · Eliminate raised thresholds if possible or make them highly visible.
Lighting · Make sure it’s easy to turn on a light BEFORE entering every room in your home. · Keep night lights turned on in hallways, bedrooms, and bathrooms. · Make sure you can easily turn on a light while in bed, before getting up. · Place flashlights in convenient locations throughout your home, and check their batteries regularly. · Light switches should be available at both the top and bottom of all stairs. · Stairway lighting should be bright enough to clearly see all steps.
Bathrooms · Tub and shower floors should have non-skid surfaces (strips or mats). · Consider installing grab bars inside the bath or shower areas and next to the toilet. · Consider installing a raised toilet seat.
Kitchen · Frequently used items should be kept on lower shelves or other places that are easy to reach. · You should have a sturdy step stool that is easy to use, preferably with a handrail. Do NOT stand on a chair to reach anything.
Stairs · Sturdy handrails should be installed in all stairways and kept in good repair.

Outside Your Home · Steps should have flat surfaces and be kept in good repair. · All steps should have handrails, preferably on both sides of the steps. · For better traction, steps can be painted with a mixture of sand and paint. · During the winter, keep all entrances and sidewalks clear of snow and ice. · All entrances should be well lit. · Consider installing ramps (with handrails).
Reconsider Personal Habits
· When walking, stay alert to unexpected obstacles — cords, furniture, pets, toys, etc.
· Avoid rushing to answer phones or the door. · Take time to make sure your balance is steady before
sitting up or standing. · Wear shoes that are supportive and snug fitting, with
low heels and non-slippery soles. · Don’t walk around with only socks on your feet. · If carrying packages, make sure your view isn’t blocked
and that you have a hand free for opening doors, holding onto railings, or steadying your balance. · Keep alert for uneven, broken or slippery pavement, sidewalks, and ramps. · Don’t rush to cross streets, especially if wet or icy. · Consider using a cane or walker. · Find out if your medications might make you feel dizzy, drowsy, or unsteady. · If you live alone, keep in regular contact with friends, family, or neighbors.
For Emergencies · Keep emergency phone numbers posted where they can
be easily seen. Consider whether they will be visible if you fall. · Make sure you can easily reach a phone when in bed.
If You Fall
1. Call 911 and other emergency contacts. 2. Stay warm by covering up with a blanket, coat, towel,
rug, or whatever you can reach. 3. Consult a doctor even if you don’t think you’ve been
seriously hurt. Falling may indicate problems with medications or be a symptom of illness or a condition that needs treatment.

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Patient’s Rights and Responsibilities
Patient/Client Bill of Rights
As a patient/client of Apria Healthcare, you have the rights which include, but are not limited to, the following: 1. Be given information about your rights for receiving homecare services. 2. Receive a timely response from Apria Healthcare regarding your request for homecare services. 3. Be given information about Apria Healthcare policies, procedures, and charges for services. 4. Choose your homecare providers. 5. Be given appropriate and professional quality homecare services without discrimination against your race, color, creed, religion, sex, national origin, sexual preference, handicap, or age. 6. Be treated with courtesy and respect by all who provide homecare services to you. 7. Be free from physical and mental abuse and/or neglect. 8. Be given proper identification by name and title of everyone who provides homecare services to you. 9. Be given the necessary information regarding treatment and choices concerning rental or purchase options for durable medical equipment so you will be able to give informed consent for your service prior to the start of any service. 10. Be given complete and current information concerning your diagnosis, treatment, alternatives, risks, and prognosis as required by your physician’s legal duty to disclose in terms and language you can reasonably be expected to understand. 11. A plan of service that will be developed to meet your unique service needs. 12. Participate in the development of your plan of care/service. 13. Be given an assessment and update of your developed plan of care/service. 14. Be given data privacy and confidentiality. 15. Review your clinical record at your request. 16. Be given information regarding anticipated transfer of your homecare to another healthcare facility and/or termination of homecare service to you. 17. Voice grievance with and/or suggest change in homecare services and/or staff without being threatened, restrained, and discriminated against. 18. Refuse treatment within the confines of the law. 19. Be given information concerning the consequences of refusing treatment. 20. Have an advance directive for medical care, such as a living will or the designation of a surrogate decision maker, respected to the extent provided by law. 21. Participate in the consideration of ethical issues that arise in your care.
The Patient’s Responsibilities
Apria Healthcare and its personnel have the right to expect from you, our patient, your relatives and friends, reasonable behavior that takes into consideration the nature of your illness or predicament. These responsibilities include, but are not limited to, the following:
1. Give accurate and complete health information concerning your past illnesses, hospitalization, medications, allergies, and other pertinent items. 2. Assist in developing and maintaining a safe environment. 3. Inform Apria Healthcare when you will not be able to keep a homecare visit. 4. Participate in the development and update of your homecare plan of service/treatment. 5. Adhere to your developed/updated homecare plan of service/treatment. 6. Request further information concerning anything you do not understand. 7. Contact your doctor whenever you notice any unusual feelings or sensations during your plan of service/treatment. 8. Contact your doctor whenever you notice any change in your condition. 9. Contact Apria Healthcare whenever your insurance company or plan changes. 10. Contact Apria Healthcare whenever you have an equipment problem. 11. Contact Apria Healthcare whenever you have received a change in your homecare prescriptions. 12. Contact Apria Healthcare whenever you are to be hospitalized. 13. Give information regarding concerns and problems you have to an Apria Healthcare staff member. 14. Contact Apria Healthcare prior to any change of address. 15. Contact Apria Healthcare if you acquire an infectious disease during the time you are receiving services and/or care from Apria Healthcare, except where
exempted by law.
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Medicare DMEPOS Beneficiary Statement
DMEPOS suppliers have the option to disclose the following statement to satisfy the requirement outlined in Supplier Standard 16 in lieu of providing a copy of the standards to the beneficiary. The products and/or services provided to you by (supplier legal business name or DBA) are subject to the supplier standards contained in the Federal regulations shown at 42 Code of Federal Regulations Section 424.57(c). These standards concern business professional and operational matters (e.g., honoring warranties and hours of operation). The full text of these standards can be obtained at http://www.ecfr.gov. Select Title 42: Public Health in the drop down box. Then browse Parts 414­429, Part 424, Subpart 424.57(c). Upon request we will furnish you a written copy of the standards.
Important Notice for Medicare Beneficiaries
Help ensure your positive airway pressure (PAP) or bi-level positive airway pressure device is covered by Medicare. For information, visit Apria.com /Medicare-PAP-Letter.
Interpretation Service Available English translation: Point to your language. An interpreter will be called. The interpreter is provided at no cost to you.

Chart provided by Language Line Services © 2007

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Notes

FOR PATIENTS RESIDING IN FLORIDA The Florida Healthcare Administration requires patients be provided the following information:
· To report a complaint regarding the services you have received, please contact the Florida Healthcare Administration Home Health Care Hotline by calling 888.419.3456.
· To report abuse, neglect, or exploitation, please call 800.962.2873.
· To report suspected Medicaid fraud, please call 888.419.3456.
FOR PATIENTS RESIDING IN MARYLAND The Maryland Department of Health and Mental Hygiene requires patients be provided the following information:
· Apria is licensed as a residential service agency by the Maryland Department of Health, Office of Health Care Quality. License No: R1114R.
· To report a complaint regarding the services you have received, please contact the Maryland Department of Health Hotline by calling 410.402.8001.
· To report suspected abuse of children or vulnerable adults, call 800.917.7383.

FOR PATIENTS RESIDING IN NORTH CAROLINA The North Carolina Division of Health Service Regulation requires patients be provided the following information:
· To report a complaint regarding the services you have received, please contact the Division of Health Service Regulation Complaint Hotline by calling 800.624.3004 (toll free within North Carolina) or 919.855.4500.
FOR PATIENTS RESIDING IN WASHINGTON The Washington State Department of Health requires patients to be provided the following information:
· To report a complaint regarding the services you have received, please contact the Washington State Department of Health Complaint Hotline by calling 360.236.2620 or by visiting its website at www.doh.wa.gov.
· To access a list of licensed providers, visit the Washington State Department of Health website at www.doh.wa.gov.
· To report suspected abuse of children or vulnerable adults, call 866-END- HARM (866.363.4276).

If you have questions, our Kaiser Permanente experts can be reached at:
888-452-4363
Apria is committed to safe, quality patient care. We encourage you to report any concerns to your local Apria branch. If your concern is not resolved, please contact
the Patient Satisfaction team at: 800.260.8808
If you are a Kaiser patient, Apria’s Customer Service team of Kaiser Permanente experts
can be reached at: 888.452.4363

AirSense, ClimateLineAir, HumidAir, and myAir are trademarks and/or registered trademarks of the ResMed family of companies.
©2024 Apria Healthcare Group LLC SLP-4443 04/24_v3

References

• ApriaDirect.com

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